title: Effects of non-dipper blood pressure pattern on left ventricular rotational mechanics in hypertensive patients with type 2 diabetes mellitus: a speckle tracking study.
abstract: We aimed to evaluate the effects of non-dipper BP pattern on left ventricular (LV) rotational mechanics in hypertensive patients with type 2 diabetes mellitus (T2DM) with the utility of two-dimensional speckle tracking echocardiography (2D-STE). Eighty-six hypertensive patients with T2DM were enrolled. All patients underwent 2D-echocardiography and 24-h-ambulatory blood pressure monitoring. Fifty-nine (59.3%) patients had non-dipper BP pattern and all subjects had normal LV function. Patients with non-dipper BP pattern had decreased systolic tissue velocity (p: 0.006), increased peak systolic apical rotation and rotation rate (p: 0.008 and p: 0.014, respectively), and peak LV twist and twist rate (p: 0.005 and p: 0.012, respectively). Analysis of LV diastolic parameters showed that, early diastolic tissue velocity (Em) was decreased and E/Em ratio and LV mass (LVM) index were increased in non-dipper group while the time to LV untwisting rate was delayed. In multivariate analysis, peak LV twist (β = 0.459, p: < 0.001) and twist rate (β = 0.388, p: 0.001) were independently associated with the difference between mean arterial pressure (MAP)-asleep and MAP-awake. In correlation analysis adjusted for age, sex and LVM index, the time to LV untwisting rate was positively correlated with the difference between MAP-asleep and MAP-awake (r: 0.290 vs. p: 0.008) and E/Em ratio (r: 0.280 vs. p: 0.010). LV rotational mechanics are impaired in T2DM non-dipper hypertensive patients, indicating LV systolic and diastolic dysfunction. 2D-STE may permit better understanding of the underlying pathophysiology and development of preventive strategies.
authors.affiliation: Department of Cardiology, Medical School, Kafkas University, 36000, Kars, Turkey, tgkdeniz@hotmail.com.
authors.forename: Tayyar
authors.initials: T
authors.lastname: Gökdeniz
authors.forename: Ezgi
authors.initials: E
authors.lastname: Kalaycıoğlu
authors.forename: Ahmet Çağrı
authors.initials: AÇ
authors.lastname: Aykan
authors.forename: İlker
authors.initials: İ
authors.lastname: Gül
authors.forename: Faruk
authors.initials: F
authors.lastname: Boyacı
authors.forename: Mustafa Ozan
authors.initials: MO
authors.lastname: Gürsoy
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D016009:Chi-Square Distribution; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D054159:Torsion, Mechanical; D016277:Ventricular Function, Left